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After reading some very insightful posts here, I've decided to register to ask for your help. My cat Dicky is not doing well at all, and after a number of tests and visits to the vet, I'm not much wiser. Any tips or advice are more than welcome.

Dicky is a male tabby of 11 years old, I've had both him and his brother since they were kittens. They never go outside, except on my balcony. His brother has been treated for urinary tract stones a few times, but Dicky has always been very healthy and happy (apart from being a bit overweight maybe). They're both neutered.

I first noticed that something was up when I had to pick up his brother to go to the vet. He had gotten heavier, which I didn't understand. In hindsight, Dicky had probably been losing his appetite, and his brother had gladly been eating the leftovers. When I started to pay closer attention, I noticed Dicky was done eating very quickly, and would go sit in a corner of the living room. His appetite seemed to get worse, despite me trying different (high quality) wet and dry foods. Even though he seemed interested in getting food, upon closer inspection he would either eat very little, or nothing at all. When he also started to smack his lips, I took him to the vet.

At the vet, again in hindsight, their first inspection was not very thorough (granted, Dicky was not very cooperative). They took blood and urine. A urine quick test showed a bit of protein, a bit of blood (though they took urine with a needle in his bladder so maybe that's why), but protein/creatine levels were good (0.8 apparently). Blood work came back, almost everything looked great. Kidneys, thyroid, sugar levels, everything was fine except for his CK (creatine kinase) levels, which were "extremely high". From what I've read online, this can be consistent with his loss of appetite and weight loss.

In the meantime, the lip smacking got worse and he started to drool quite severely. Thick, clear wads of slime hung from his mouth. The vet gave him a shot against nausea and I believe Mirtazapine to improve his appetite. None of which seemed to do much good.

Dicky smelled bad from the mouth as well, so when I got back to the vet, they inspected his mouth a bit better and found some bad teeth and sores on the roof of his mouth. The vet believed this was the cause of his troubles, I got Meloxidyl to give to Dicky and we made an appointment for next week to have some of his teeth removed. Though the drooling is almost gone and he rarely smacks his lips now, after a week on Meloxidyl, his bad breath was not as bad, the sores on the roof of his mouth reduced to some reddishness, but appetite is still a problem and he wants to be with me more than ever. He's clearly feeling horrible.

This Saturday, Dicky's one pupil was suddenly much less dilated than the other. I learned that this is called Anisocoria. The vet advised me to bring him in right away to do a FeLV/FIV test. I did, yesterday, and the test came back negative.

Everything combined, the vet told me to cancel the appointment to get his teeth removed for now, because she does not believe his teeth are the main cause for everything that's happening. She suspects something in his head is the problem, and has advised an MRI scan as a next step in diagnosis.

This all has also made me feel horrible, because not only is my cat clearly not happy, costs are quickly increasing and an MRI scan would add 800 euros to the bill. And I think, what can come out of the MRI scan, and what will I do with the results? If there is a cancer, I don't want to put him through chemo therapy. If nothing is found, we're back to square one.

In the meanwhile, the vet seems reluctant to offer anything else. And maybe there are simply not a lot of options. Before the pupil incident, I had gotten a second opinion from a US vet, who suggested antibiotics and possibly a stronger painkiller. My vet says she doesn't think antiobiotics will help and that there are side effects, and that a stronger painkiller would also make him more sedated, which would make it more difficult to identify what's happening underneath. That makes sense of course, and at the same time my furry little friend is not happy and it breaks my heart.

One last detail to mention, is that Dicky has gotten a good dose of Gabapentin to make him calmer for his vet visits. It seems like when that wears off, his appetite and behavior seem a bit better for a short time, to then get worse again. Maybe this is normal, but I thought it good to mention. Also, his fur is still soft and shiny (apart from some drool here and there). Toilet behavior is difficult for me to monitor, as I'm not home during the day.

With normal kidney and blood-work readings normal in most cases, together with bad teeth, mouth sores and bad breath, lastly the eye change, this is screaming "stroke" or some sort of ischemic reduction in blood flow to the brain. So, given the slow onset and mix of other symptoms, in rank order:

a) Significant infection of the sinuses, initiated by the bad teeth, and now spreading into the brain.
b) Ischemic stroke
c) Tumor

Yes, pretty much only an MRI will give you an accurate indication of soft-tissue problems. The Gabapentin is a specific for seizures and nerve damage, and his response seems appropriate to some sort of neuropathy.

As you are somewhere between 3,500 and 4,500 miles away, and I am not a vet, were he my cat, I would:

a) Get the teeth out immediately, first thing ASAP. The connection between bad teeth, stroke and other forms of neuropathy is very well established in humans, certainly.

b) Initiate a massive course of antibiotics to clear any residual infections. This will have to be "like religion" on your part to make sure the doses are timed properly - not much sleep for you for the next two weeks, or so. Ask your vet about the advisability of steroids at some point - if only to reduce swelling - along with the antibiotics. Steroids are hell on the liver, but are also very effective.

c) Have him checked for an impacted hairball - stranger things have happened, and if he has a significant, but only partial bowel obstruction, all of the symptoms you describe would be possible, even if unlikely. The point being to make sure that 'the obvious' has also been checked before chasing down the exotic.

d) And, only then, if he does not improve significantly, consider an MRI.

One more thing: Meloxidyl is an NSAID, and will do nothing for any underlying infection - which, clearly, is going on here, whether the blood tests show an elevated white count or not. High CK levels (in humans) is also a side-effect of heart attacks. Nor will a brain infection (again, in humans) always raise the white blood cell count to alarming levels. If your vet has the ability to test for a specific white cell (neutrophils), abnormalities there would be far more sensitive to a brain infection than an overall count. Which, again, might look perfectly normal.